OBJECTIVES:

The cost effectiveness of different antihypertensive medications used in combination or alone has not been examined among patients with essential hypertension in Saudi Arabia. Therefore, the aim of this study was to examine the cost effectiveness of different antihypertensive monotherapies in the management of essential hypertension using real world data in Saudi Arabia.

METHODS:

This was a retrospective cohort study in which adult patients (≥18 yrs.) with essential hypertension on a single antihypertensive medication, without malignancies or cardiovascular disease, and with complete data for 12-18 months were recruited from the electronic health records of a university-affiliated tertiary care center in Riyadh, Saudi Arabia. The Incremental Cost Effectiveness Ratio (ICER) was calculated based on the acquisition cost of different antihypertensive medications in Saudi Riyals (SAR) per one mmHG reduction in systolic blood pressure. Propensity score bin bootstrapping with 10,000 replications was conducted to generate the 95% confidence intervals for both treatment outcome and cost.

RESULTS :

The number of patients who met the inclusion criteria and were included in the analysis was 153. Patients' mean age was 56 years, and about 56% of them were female. There were 111 patients on angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), and 44 patients on amlodipine. The ICER for the use of amlodipine versus ACEIs or ARBs was SAR 76.67 per 1 mmHG reduction in systolic blood pressure. The use of ACEIs or ARBs would result in lower cost and better outcome 55.26% of the time, and lower cost and outcome in 44.74% of the time.

CONCLUSIONS:

The use of ACEIs or ARBs monotherapies seems to be more cost effective in comparison to amlodipine in the management of elevated systolic hypertension. Future studies should examine the cost effectiveness of different antihypertensive treatment regimens among patients with hypertension in Saudi Arabia.